Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G67619 | CA |
NPI | 1043257082 |
---|---|
Provider Name | Dr. Mark James Borigini |
First Address | Lomita, CA 90717-0667 |
Second Address | Downey, CA 90242-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F11225 | (02) |